Blood Positive, Culture Negative Twice

[gonecrazy]

Terri,

I have a perplexing case that I hope you can help me with. I was originally tested as an annual checkup for all STDs including HSV1 & HSV2 on 08/12/2014. The test came back negative on all accounts. I was sexually active with several partners at this time, some unprotected.

I started dating my current girlfriend around this time period and became sexually exclusive to her shortly after I received my test results. I can’t remember the exact timeline, but we both started experience symptoms of herpes. I felt mine was folliculitis due to shaving down there. She did experience blisters around her buttocks area which appeared to be herpes, but I’m no professional.

She got a blood test and the results came back negative for HSV. I did end up going back to the doctor to get the folliculitis examined on 09/11/2014 and the doctor concurred she felt the same.

Most recently I started getting symptoms again with watery blisters in different areas of my genitals at separate times. On 05/20/2015 I went back to the doctor to get a swab test done during one of the outbreaks. These results came back negative for HSV.

At this point I’ve had several outbreaks of symptoms which appear to be herpes (blisters in genital area). I just received my test results back on my most recent visit on 8/28/2015. The doctor performed a swab test on the lesion area and pulled blood. My IgG blood levels came back at 19.10 for HSV1 and 10.80 for HSV2, but the swab test came back negative.

My question is which test should I rely on and can I say definitively that I do or do not have herpes?

Thanks!

[Terri Warren]

Do you live in the US? What lab did you go to to have your bloods drawn, do you recall? Quest, LabCorp? It probably says on the lab sheet

Terri

[gonecrazy]

Yes, I live in the US. It doesn’t show which lab on the sheet, but I can find out from the doctors office. Do you have a response on why my PCR swab test would come back negative, but blood levels would be so high?

[gonecrazy]

It appears LabCorp did both tests.

[Terri Warren]

OK if LabCorp did both tests, then I would believe that you have both HSV 1 and HSV 2 infection. The test is Captia (done by LabCorp) and these values are well above the range where we wonder if confirmation is necessary. When someone has well established infection, the body is able to clear virus out of lesions pretty quickly and thus a false negative PCR. And are you sure it was PCR, not culture?

Either way, I would rely on the high HSV 1 and 2 index values, indicating infection (and infectiousness) with both. I’m not clear what happened with the previous antibody tests but it could be that the testing was done too soon after infection to be accurate. It is also possible that you had folliculitis accurately diagnosed but that you also had herpes. Don’t know that for sure but both are possibilities

Terri

[gonecrazy]

It may have been a culture. The labs shows culture negative and HSV 1/2 PCR negative. The doctor believes I may have been exposed to the HSV 1 & 2 virus, but doesn’t feel I am positive for HSV. This is a little confusing to me.

Which test is more accurate, blood or culture?

[Terri Warren]

In this case, the blood test. I wonder if somehow he ordered and HSV 1 and 2 PCR from you blood? That would not be correct but sometimes it does happen by mistake. The culture, if that is what was done from a lesion, is four times more sensitive than culture and that could be why it was missed. It would not make sense that he ordered both culture and PCR from a lesion. If you would like a different reference, I would suggest that you go to the 2015 CDC STD treatment guidelines and read about how to interpret a positive IgG HSV 2 serology.

Terri

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